Insurance mess

Well, the good news is that I may be going home sooner than expected. The
bad news is the reason-while my OB has stated that he prefers to keep me on
hospital monitoring, apparently Blue Cross/Blue Shield has decided I'm
stable enough to go home, even with a history of things coming on rapidly
and severely, without any real symptoms. At least part of the justification
is that if things start to go bad, after all, they can deliver the baby now
and she'll probably be OK-so even though I'm doing much better on hospital
bedrest than I was on bedrest at home, which could make the difference
between a baby who has to go through NICU and one who is near full-term, I
guess the actuaries have decided that it's better to risk damage to Cuddles
and/or me than to pay for it.

So, at this point, it's up to my doctors to justify keeping me in-patient
with BC/BS, or to send me home and monitor from there, until the next time
something spikes. And I'm not sure exactly what happens financially if my OB
decides that I should stay if BC/BS disagrees-and I'm not completely sure
that I won't get a bill from these last couple of days, where BC/BS
apparently didn't consider them justified.

Mostly, I'm terrified-if my doctor had said on Monday "Your BP is down,
tests are normal, I think the blood pressure surge was just a fluke", I
would have felt good about going home and relieved about doing so. Now,
though, even if he agrees that I'm stable, I know it's because the insurance
is pushing it, which means that decisions about me and Cuddles are being
made based on financial reasons from someone who doesn't really know me or
my history, and doesn't care-and probably doesn't particularly care what the
outcome of my pregnancy is as long as it doesn't cost them too much money.

Anyway, I'll let everyone know how this turns out.

"Donna Metler" wrote in message
. ..
Well, the good news is that I may be going home sooner than expected. The
bad news is the reason-while my OB has stated that he prefers to keep me
on
hospital monitoring, apparently Blue Cross/Blue Shield has decided I'm
stable enough to go home, even with a history of things coming on rapidly
and severely, without any real symptoms.


This is just nuts. Since when is an insurance company better qualified to
make medical decisions than a doctor. If that had happened to me I would
have been hopping mad which of course wouldn't be a great thing for the
blood pressure.

Hope everything works out regardless of the outcome with insurance.

"Donna Metler" wrote in message
. ..


Mostly, I'm terrified-if my doctor had said on Monday "Your BP is down,
tests are normal, I think the blood pressure surge was just a fluke", I
would have felt good about going home and relieved about doing so. Now,
though, even if he agrees that I'm stable, I know it's because the
insurance
is pushing it, which means that decisions about me and Cuddles are being
made based on financial reasons from someone who doesn't really know me or
my history, and doesn't care-and probably doesn't particularly care what
the
outcome of my pregnancy is as long as it doesn't cost them too much money.

I have Premera Blue Cross insurance, and I had a caseworker, a nurse
assigned to my case to help smoothe out things like this. So when I was on
bedrest in the hospital, and I was able to go home on bedrest, she arranged
in a day for me to have a hospital bed at home, and she arranged its
delivery and assembly and everything. It was beautiful. You should call
your insurance company and ask to talk to your caseworker, and if you don't
have one, ask to have one assigned to your case. If that doesn't work,
maybe my old caseworker can pull a string somewhere for you, I don't know if
it's the same company or just an affiliate.

--angela

decisions about me and Cuddles are being
made based on financial reasons from someone who doesn't really know me or
my history, and doesn't care-and probably doesn't particularly care what the
outcome of my pregnancy is as long as it doesn't cost them too much money.

Anyway, I'll let everyone know how this turns out.

Oh! this is so horrible, something has to be done about the health care system
in the U.S., it's stories like yours and my own experiences when my DS was born
that really make me hate this system where the bottom line is always the dollar
not the welfare of the patient.

Ok, rant over, I hope all will be well for you and your baby.

Clare
Sam 5.27.04

OK-I've now talked to the case manager (about 3 times today now), who seems
willing to work with me (and was much more reassuring than the one in the
hospital, who seemed to have the "you can always come back if something goes
wrong, and then the insurance will cover again" attitude)-my hospital stay
has been approved through October 31, with another review after that, so we
have a few more days to see if I either remain stable or if there's reason
to extend. Whew!!

argh!!!!! How frustrating! Nothing like an insurance issue when in the
hospital for a medical problem r/t BP. Sheesh.

Kelly

"Donna Metler" wrote in message
. ..
Well, the good news is that I may be going home sooner than expected. The
bad news is the reason-while my OB has stated that he prefers to keep me
on
hospital monitoring, apparently Blue Cross/Blue Shield has decided I'm
stable enough to go home, even with a history of things coming on rapidly
and severely, without any real symptoms. At least part of the
justification
is that if things start to go bad, after all, they can deliver the baby
now
and she'll probably be OK-so even though I'm doing much better on hospital
bedrest than I was on bedrest at home, which could make the difference
between a baby who has to go through NICU and one who is near full-term,
I
guess the actuaries have decided that it's better to risk damage to
Cuddles
and/or me than to pay for it.

So, at this point, it's up to my doctors to justify keeping me in-patient
with BC/BS, or to send me home and monitor from there, until the next time
something spikes. And I'm not sure exactly what happens financially if my
OB
decides that I should stay if BC/BS disagrees-and I'm not completely sure
that I won't get a bill from these last couple of days, where BC/BS
apparently didn't consider them justified.

Mostly, I'm terrified-if my doctor had said on Monday "Your BP is down,
tests are normal, I think the blood pressure surge was just a fluke", I
would have felt good about going home and relieved about doing so. Now,
though, even if he agrees that I'm stable, I know it's because the
insurance
is pushing it, which means that decisions about me and Cuddles are being
made based on financial reasons from someone who doesn't really know me or
my history, and doesn't care-and probably doesn't particularly care what
the
outcome of my pregnancy is as long as it doesn't cost them too much money.

Anyway, I'll let everyone know how this turns out.

WHEW! Is your blood pressure better just knowing you are in the hospital
being monitored for a few more days?

Kelly

"Donna Metler" wrote in message
. ..
OK-I've now talked to the case manager (about 3 times today now), who
seems
willing to work with me (and was much more reassuring than the one in the
hospital, who seemed to have the "you can always come back if something
goes
wrong, and then the insurance will cover again" attitude)-my hospital stay
has been approved through October 31, with another review after that, so
we
have a few more days to see if I either remain stable or if there's reason
to extend. Whew!!

Definitely-and if things stay stable for a few more days, then maybe we'll
all be more confident about me going home.


"Kelly" wrote in message
...
WHEW! Is your blood pressure better just knowing you are in the hospital
being monitored for a few more days?

Kelly

"Donna Metler" wrote in message
. ..
OK-I've now talked to the case manager (about 3 times today now), who
seems
willing to work with me (and was much more reassuring than the one in
the
hospital, who seemed to have the "you can always come back if something
goes
wrong, and then the insurance will cover again" attitude)-my hospital
stay
has been approved through October 31, with another review after that, so
we
have a few more days to see if I either remain stable or if there's
reason
to extend. Whew!!

I am so sorry, Donna. I HATE insurance companies. I could tell you a lot of
TennCare horror stories, myself.


Leslie

Emily (2/4/91)
Jake (1/27/94)
Teddy (2/15/95)
William (3/5/01 -- VBA3C, 13 lbs. 5 oz.)
and Lorelei, expected 11/2/04

"Children come trailing clouds of glory from God, which is their home."
~ William Wordsworth

"Leslie" wrote in message
...
my hospital stay
has been approved through October 31, with another review after that, so
we
have a few more days to see if I either remain stable

Well, that is good news, but OTOH it makes so much sense for you to have
to be
stressed out about all this when they are trying to control your BP!!!!

That's what my peri said when he came through this evening-that based on
what my BP was doing, it was probably worse for me to be here in the
hospital than home on bedrest if the insurance was going to put me through
that mess every few days (and due to HIPPA, apparently my husband can't deal
with me for them until we get some legal paperwork filed). So, the plan is
to run every test in the book tomorrow, and if there is still nothing which
insurance will readily accept, try to set up some support for home health
care so I can do bedrest more at the level we're doing it in the hospital,
which seems to be working, at home so I can go home sometime this weekend. I
get the definite impression that he and my OB both really think that a spike
is likely, but that insurance companies don't accept instincts and
experience as being enough to justify services.



Leslie

Emily (2/4/91)
Jake (1/27/94)
Teddy (2/15/95)
William (3/5/01 -- VBA3C, 13 lbs. 5 oz.)
and Lorelei, expected 11/2/04

"Children come trailing clouds of glory from God, which is their home."
~ William Wordsworth